The Makings of a Child Abuse Professional Forensic Nurse

WhatWeDo

By Cynthia Leahy, MSN, RN, SANE-A, SANE-P, Forensic Nurse Examiner Program Coordinator, Winchester Medical Center

According to Google there are about 66,000,000 results for the ‘definition of nurse’.

  1. nurse/nərs/
  2. noun
    1. a person trained to care for the sick or infirmed, especially in a hospital.
  3. verb
    1. give medical and other attention to (a sick person).

I didn’t think to consult Webster when I was contemplating Nursing as a profession back in the 1980s (Google wasn’t a thing). Anyway, everyone knows that a nurse provides ‘care for the sick’, but is that what forensic nurses do?

As I scroll down through our office’s collection of thousands of pictures of children and their injuries, it seems kind of crazy that my journey in search of nursing excellence landed me here. The first half of my nursing career really helped prepare me for this unique role. All those years spent as a childbirth instructor (explaining female anatomy to a room full of strangers), hours in a cold morgue as an autopsy-assistant, and most importantly in the one place where responding to and managing trauma is the order of the day, the emergency department. Time in my chosen nursing roles seemed to provide plenty of opportunity for interaction with the skills that would prepare me to become a Forensic Nurse Examiner.

This drawing is an example of how a detailed diagram, in this case suspected immersion burns, lends a 360-degree view of a child’s forensic medical findings. The forensic photographs are critical to a drawing’s accuracy; both part of the forensic medical provider’s role.

All nurses do more than the description in that first over-simplified definition. Forensic Nursing, what I do, is “the practice of nursing globally when health and legal systems intersect (ANA & IAFN 2009).” This expertise evaluates patients when there is a chief complaint of violent crime, or concern of maltreatment. Maltreatment pertains to vulnerable populations, children (pediatric) being one.  These programs and providers remain few and far between because it requires a unique skill set that depends upon specialized knowledge, plus 24/7 availability. If biomedical evidence is suspected as on or in a living person, ideally the recovery is timely, and by a specially trained healthcare provider skilled at utilizing forensic principles of evidence collection. Even more specialized is the actual examination of the patient, as outcomes may rely on an accurate interpretation of what is found (with all things considered).

Forensic medical and/or nursing programs often exist in hospital settings, and focus on one or more patient population where needs from the healthcare and legal systems overlap. The program here at Winchester Medical Center (WMC) in Winchester, VA provides on-call services for violent crime complaints and maltreatment concerns. When I joined the program in 2000, we primarily conducted sexual assault evaluations. However, with the development of CACs and multidisciplinary teams in Virginia and West Virginia, child maltreatment became our highest caseload. Maltreatment is a term that encompasses all forms of abuse, neglect, and exploitation. Many forensic nursing programs like ours, have had to widen their expertise beyond SANE (Sexual Assault/Abuse Nurse Examiner) to FNE (Forensic Nurse Examiner).

As an FNE, the medico-legal response to the investigation of child maltreatment is complex; somewhat like trying to put a 500-piece puzzle together. It is a process. Having a multi-pronged approach; the pooling of resources and talents of all the disciplines involved, is the best case scenario. My decision to become a nurse has been quite a journey, and it’s brought me to this place where being a nurse means far more than ‘a person trained to take care of the sick.’

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